Direct‐acting antiviral agents in the treatment of chronic hepatitis C—Real‐life experience from clinical practices in Pakistan

Abstract

This study aims to evaluate the clinical effectiveness in terms of sustained virological response (SVR), predictors of SVR and safety of available second‐generation generic direct‐acting antivirals in Pakistani chronic hepatitis C patients. This is a retrospective study conducted in multiple centers of Pakistan from January 2015 to January 2019. The samples include patients infected with chronic hepatitis C virus, regardless of virus genotype, cirrhosis, or prior treatment. A total of 993 patients were included in the present study, with the majority receiving sofosbuvir with daclatasvir (95%), sofosbuvir with daclatasvir and ribavirin (4%), and sofosbuvir with ribavirin (1%). There were 96% cases of chronic hepatitis, 3% cases compensated cirrhosis, and 1% cases of decompensated cirrhosis. Genotype 3 (99.6%) was the most common genotype. Overall SVR after 12 weeks was 98% for all treatment regimens. High SVR12 was observed with sofosbuvir in combination with daclatasvir (98.5%), then sofosbuvir in combination with daclatasvir and ribavirin (90.2%) and sofosbuvir in combination with ribavirin (75%). SVR rates were high in chronic hepatitis C patients (98.2%) as compared with cirrhotic patients (92.1%) and it was high in treatment‐naive (98.8%) then interferon experienced patients (90.1%). In multivariate binary logistic regression analysis, patients’ education status, treatment strategy, viral load, and alanine aminotransferase had a statistically significant association with SVR at 12 weeks. No major adverse events occurred which required treatment discontinuation. Generic oral direct acting antiviralss (sofosbuvir with daclatasvir) achieved higher SVR12 rates and were well tolerated in this large real‐world cohort of genotype 3 infected patients.

Risk of adverse outcomes following treatment with direct acting antiviral drugs in HCV infected patients with liver cirrhosis

“…Therefore, our study confirmed that response rate of DAA drugs is independent of gender and age. In contrast to the findings of our study, Mushtaq et al (2020) reported high response rates in male as compared to females [ 14 ]. We examined majority of patients in both study groups were in middle age group i.e 40-60.…”

Sustained virological response in patients with HCV treated with daclatasvir plus sofosbuvir, with or without ribavirin: a large, field-practice study

“…In the analyzed population, 98% of patients reached SVR12, while 12 (2%) patients had virological failure. These findings confirm the high pan-genotypic effectiveness of the studied combination in patients with advanced liver disease, as shown in other studies, 9 – 16 attributed to the mechanism of action characterized by the direct inhibition of viral replication. Given the high rate of treatment success, we were not able to investigate the potential predictive factors.…”

A Two-Year Outcome Evaluation of Government-Led Initiative to Upscale Hospital-based Hepatitis C Treatment Using a Standard Two-Drug Regimen in Malaysia

“…It is noteworthy that some of these studies generated their findings from either a clinical trial or a structured treatment accessibility program (12)(13)(14)(15). A few of them were undertaken in settings in which the sofosbuvir-daclatasvir combination only served as an option among many others (16)(17)(18)(19)(20)(21)(22)(23), while the rest presented the data limited to specific populations, HCV genotypes and liver cirrhotic status (24)(25)(26)(27)(28)(29)(30)(31)(32).…”